Hello everyone 👋

We are back this week with another episode of Tech Tuesday. This month we are chatting with Blake Rutherford, who is the co-founder of a mobile app called ROOTINES. The app is intended to make the transition to home smoother and is available to both parents and providers for free on the app store.

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You can get in touch with Blake and the team at Rootines by clicking on the business care below:

You can find out more about Rootines, by visiting their website. Click here or on the image below:

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The transcript of today's episode can be found below 👇

[00:00:00] Ben: [00:01:00] hello everybody. Welcome back to the Incubator podcast. It is Tuesday. We are back with another episode of Tech Tuesday, Daphna. How's it going this morning?

[00:01:09] Daphna: But I love Tech Tuesday and I, I have a, there's a special place in my heart for NICU follow up, so I'm especially engaged

[00:01:17] Ben: Yeah. I feel like I'm gonna have an easy time today. I feel you're gonna, you're gonna hog the ball as

[00:01:21] Daphna: You too have a history in doing NICU follow

[00:01:24] Ben: That is true. We have the pleasure of having on with us, Blake Rutherford, who is the co-founder and Chief medical Officer of routines.

[00:01:32] Ben: Blake is a lifelong NICU medical sales professional. After attending University of Kentucky, Blake entered the field of medical sales where he has held a number of roles supporting sales of nicu, women's health, respiratory therapy, and pediatric products. In total, he's represented over. 40 different companies and product lines.

[00:01:48] Ben: In 2010, he co-founded NICview. So if you've ever used these cubic c cameras in your nicu then you've used some of Blake's products with Dominic. Foster, NICview was the [00:02:00] first commercial remote viewing system for nicu, and the two built the company until a successful.

[00:02:05] Ben: Exit to a major medical device company in 2015. Both Blake and Dominic stayed on with the medical device company working on the NICU product line until leaving to build A S D A I L C and its flagship product routines, which we are here to talk about today. Blake is an exceptional storyteller that can articulate the value proposition of a product while applying it to his audience.

[00:02:27] Ben: Pain points from his longtime career in pediatric medical sales and his experience with NICview. Blake has learned that family-centered care and support for parents is paramount in building a healthcare ecosystem that encourages its pediatric patients to thrive. Blake, thank you so much for being on the show with us this

[00:02:44] Blake Rutherford: Yeah. Thank you very much for having me. I really appreciate it.

[00:02:48] Ben: The first thing I wanna say is we're here to talk about this app that you've developed called routines. It's spelled r o t i n e s, like roots. And for the audience members who are not [00:03:00] familiar with the app yet, can you give us a two minute overview of what the app is and what the app

[00:03:06] Blake Rutherford: Sure, no problem. Again, I really appreciate your time. Throughout the time that we spent Dominic and I developing NICview one of the really the major pieces of feedback we got constantly was specifically from parents and parents wanting more access to their baby in the nicu. Two more educational resources to more ways to understand what was going on every day while they were there in the hospital.

[00:03:32] Blake Rutherford: So ironically during that time, my second child was born and I got the NICU experience as well. so my second little girl was born at about 33 and a half weeks and spent about five weeks there in the unit. Surprising to all of us. Once we got home, really the most important memory that I have, short of all the fun that I had with another brand new baby was that.

[00:03:57] Blake Rutherford: Man, this was a lot more [00:04:00] difficult than I realized it was going to be. I had a lot more questions than I could possibly have thought. Things were far more tenuous with her, even though she was mostly just a feeder grower. And really, I spent a lot of time reaching back out to the friends that I had made over the course of my career saying, what about this?

[00:04:18] Blake Rutherford: Or what about that?

[00:04:21] Daphna: So

[00:04:21] Blake Rutherford: Really, the advent of routines came from all the knowledge that we gleaned from NICview. It was really a virtual nursery window to begin with, but it really morphed into a way for clinicians and parents to stay connected even through simple things like family notes or the ability to just simply take a snapshot if you're a parent.

[00:04:42] Blake Rutherford: And come back in and talk to the clinicians about what you saw at that particular time at 3:00 AM when you just had to get up and take a quick look at what the baby was doing there in their incubator. So routines at its core is a further development of that same sort of patient engagement [00:05:00] or connection between the clinic.

[00:05:02] Blake Rutherford: Now, the high risk infant follow up clinics. And those parents that are out there still working hard to keep their babies, safe, fed and I guess under small amounts of stress. So you mentioned earlier that the product itself, consists of a couple of apps. Obviously there's one for iOS and one for Android. But the other side of it is the clinical facing side in which we have a robust portal. I actually recently listened to your podcast with Dr. Summers and, he had a lot of very pointed and very intelligent things to say about how we've morphed away from what happens within the walls of the facility.

[00:05:46] Blake Rutherford: And we've begun to focus more on. Really what's happening once that baby goes home. So I think at its core, the idea behind routines is we would like to create that link [00:06:00] much, establish it much more deeply than it is currently back to the facility in order to really keep parents engaged and help them understand that with any of those types of questions, concerns, et cetera.

[00:06:13] Blake Rutherford: They do have someone there at the clinic that they can reach out to. Of course, all the different alerts, triggers, reminders, other engagement tools are also baked in there. And then likewise, we run obviously full-time technical support for parents or clinicians or whomever might have any questions about what's going on with the actual platform. So in a very brief nutshell, that's routines.

[00:06:38] Ben: And so when the user, in my opinion, that this is the most important for is probably the parent. And I think if we put ourselves in the shoes of the parent when they open the app what is the kind of experience that they have? Is it an app that gives them information?

[00:06:57] Ben: Is it an app where they enter data? How does [00:07:00] that user experience feels like for

[00:07:02] Blake Rutherford: Sure. So to begin with, we really rely a lot on patient reported, or in this instance, parent reported data. So each setup that we might deploy for a particular clinic or a particular hospital system, would be completely customizable for their needs. So some facilities we've spoken to, this is really driven a lot through feeding and lactation.

[00:07:24] Blake Rutherford: And they may want to know all about the mode of delivery for that particular feed, how much the baby took, whether or not that feed was fortified, et cetera. And then they would like a weekly weight, for instance. So we would do that quite simply by providing them with a scale again, that could be automatically uploaded into our cloud and reported back to the clinic.

[00:07:45] Blake Rutherford: Or it could be something more specific in which they're just basically reading what they see on their own infant scales. So when the parents open the app, they're going to see what, hospital A has decided they would like to collect [00:08:00] from them. On the other end, we spent a lot of time and a lot of effort making sure that this setup is exceptionally simple.

[00:08:08] Blake Rutherford: For the parents to use, the last thing we would want is anyone sitting, all day long entering data or feeling bad that they missed, oh my gosh, I forgot to enter that feed, or I didn't mention how well the baby, ate that particular time. So therefore

[00:08:22] Blake Rutherford: we really rely on trended information.

[00:08:26] Blake Rutherford: So again, being able to really add up what's happening over time, I think is what's most valuable for everyone involved. That specific feed may not have gone well, but overall we're very excited to say that, the feedback has been great in terms of displaying that information, not just for the clinic, but also for the parents, giving them some solace in the process.

[00:08:50] Daphna: Yeah, and I, to your point, even just the type of features that I think are available. Like for people to even pick from, what does the baby's routine, quote [00:09:00] unquote look like? What's the baby's sleep like? The medication list. I love that. The options for like stress level and baby mood, like how long were they crying?

[00:09:11] Daphna: Those things are important. Stooling patterns, things that. Parents are taking note of. But if you can think about early parenthood, those sleepless nights like crying always seems much longer than it really is. Or maybe it seems like the baby is stooling much more, much less than they should be.

[00:09:29] Daphna: I think this really helps us have a common language. This data is like a common language about what's actually happening in the home. Because sometimes I think. In either direction. Parents can lose track of that just cuz there's so much going on. They're physically and mentally, emotionally exhausted and this is a way for them to really keep track of those things.

[00:09:51] Daphna: And I think for somebody who brings them into the clinic or that has a virtual touchpoint with them can say, yeah, this is within [00:10:00] normal. Like it seems like a lot, but this is. Normal or this is like getting into the realm of not normal and this is something we need to do something about. I think that is great.

[00:10:11] Daphna: The other thing I wonder if you get a lot of feedback on is it seems very empowering for parents and I think that's something that parents feel they lose in the nicu.

[00:10:23] Blake Rutherford: I think so as well. And you mentioned something there that, touched a nerve with me even it seems as if everything, when you bring that baby home is very acute. It's a disaster that moment. And oftentimes, in between even those scheduled appointments with your pediatrician, tons of things come up.

[00:10:41] Blake Rutherford: And I think that. If I had to really narrow down, if I could choose the perfect outcome for each of these deployments, it would be simply that we are beginning a data stream surrounding that individual child, not the population of children with a particular condition, or [00:11:00] all the babies born at 32 weeks that we're just discharged, but in instead that specific child and the way that child behaves.

[00:11:08] Blake Rutherford: If we can start that data collection, even, earlier in the NICU with a few different simple things like how much time did you do swaddled bathing this week? Did you spend any time reading to your baby there in the bed space? How comfortable are you with the education you got about the feeding tube your child will go home with?

[00:11:27] Blake Rutherford: All of those sorts of things will lead to not just more empowered parents, but a tighter bond between that facility. And those specific babies that are going home. I've heard time and time again across all the facilities we've spoken to, all the parent groups that have been involved in this, that there is the cliff feeling once you're handed your baby, you're handed a stack of paper, as has been mentioned, and a whole bunch of education.

[00:11:54] Blake Rutherford: And again, from personal experience. While I appreciated all of that and while all of that did prepare [00:12:00] me somewhat, It went out the window, 24 hours later when that baby, was there in my arms and I forgot all of it. So just having the ability for a free flow of information, not just from the parents into the clinic, but I think equally importantly, from the clinic back out to the parents.

[00:12:19] Blake Rutherford: So the routines platform allows for surveys, educational tools, uploaded videos. Tons of different ways that you can reach out and touch those parents and make sure that they feel that, they have a partner in this if nothing else.

[00:12:36] Ben: To me it, I'm gonna give an analogy of what I feel like routines is doing, and I think it's, it makes me chuckle. But looking at first and foremost, the time of discharge from the nicu. I don't know if you guys remember when we used to travel with our families. By plane back in the old end, you, your dad arrived at the airport with a stack of paper.

[00:12:55] Ben: Like you had you had the visa, you had the tickets, you had this, and you arrived with this little binder [00:13:00] of all the things you were gonna need on the trip. And it was always a mess, right? And so I feel like this is what the NICU discharge experience is like. Cause like, all right here are the medications you need on the piece of paper with the schedule.

[00:13:09] Ben: Here are your discharge summary. Here's your other appointments, and the parents leave. With these stacks of paper and they're just like trying to keep their head straight on the way home. And I think what routines is doing is that it's bringing that into the 21st century, which is, all right, let's just give an nap and say, right here are the meds you're supposed to be on.

[00:13:26] Ben: Here are the doses, here's the frequency. If you want to put it on a schedule, here's a little calendar view where you can see when everything is due. And it's oh my God. It's like now traveling and just showing your phone and scanning the QR code and going through check-in. It's just.

[00:13:38] Ben: To me, it feels very much similar to that. And then I, would you agree? Would you agree Blake?

[00:13:43] Blake Rutherford: I totally would. In the three years that we've been working on this, somewhat in the background during the pandemic, and then a little bit more visibly here recently, w we've learned so much about how many facilities are very [00:14:00] forward thinking and are currently retooling what their follow-up clinic looks like.

[00:14:04] Blake Rutherford: In fact, if you just Google around, you'll find all kinds of fun new articles all about how great. These follow-up clinics have become, the question really is not as much early adoption, but I think how do you manage all of this data that's coming in? So we all know that the data's only as good as, really the way it's reported and what's necessary to you.

[00:14:27] Blake Rutherford: There's tons of devices we could link up to this. There's all kinds of new remote patient monitoring tools that come out every day. There's even simple stuff like under bed sleep sensors, right? So what of that data stack really is most valuable to the clinical space? Whether it be from a medical point of view or from an overall, again, engagement point of view and what do we do with it?

[00:14:51] Daphna: what

[00:14:52] Blake Rutherford: So your analogy of, of course the triptych or the giant list of papers, which I think my father would still show up to the airport with. [00:15:00] I think that's spot on and the move away from that into a more digital health mindset when it comes to this particular population is underway.

[00:15:11] Blake Rutherford: It's just very early. So if we think even like the EMR is a great example. If I were to tell everyone, we would like the parents to be able to upload a weight and do that every single solitary week, and we would like to put that into the emr. Oftentimes, if I make that comment, I get the deer in a headlights look back from the facility that says, we don't have a place for that in the emr.

[00:15:36] Blake Rutherford: We don't know what to do with that. Is that in the notes section? That's now clinically reviewed. What do we even do with all of this information that supplying to us? So I think there's some hurdles to overcome, but we'll get there.

[00:15:48] Ben: But I want to come back to that because I think it could be maybe confusing the way we've presented the app so far from the standpoint of we're really talking about this link between the families and the institutions, right? But number one it [00:16:00] doesn't have to be, An institution, it could be, for example, a pediatrician's office, right?

[00:16:03] Ben: I mean you, it doesn't really need, it doesn't, I don't want neonatologists and neonatal providers to feel like, oh, is this something you may not even implement it. It might end up being something that a pediatrics office that deals with a lot of post NICU babies follow up. Say, Hey, this is a great way for me to just keep track of these 15 kids that were former 26 weekers that I'm all following that are in on a bunch of meds, that some of them are on oxygen It doesn't have to be a hospital or healthcare system.

[00:16:30] Ben: It could be an individual practice that decides that, hey, we have enough nicu baby follow up, that we need a better way to keep track of them. Is that

[00:16:37] Blake Rutherford: That is completely correct. And the beauty of this, much like everything else that we do with our phones nowadays, is it can be connected across the continuum. So all of the care team that might be involved with that patient all the way from the neurologist through, O T P T and the individual pediatrician, every last one of those people is seeing the same data, has the ability to enter data or [00:17:00] consume that data in any way that they see fit.

[00:17:02] Blake Rutherford: So I think being flexible is probably our claim to fame.

[00:17:07] Ben: And beyond that specific flexibility you have even more flexibility from the standpoint of We don't want people to think, oh, if my pediatrician doesn't have that in place, then it's a matter of luck. You could, if you're a parent, you could technically go on the app store, download it, and let's say your NICU is not there yet, they're not yet at the point where they can set you up with that nice discharge planning, but you could.

[00:17:30] Ben: Yourself say, Hey, I'm gonna use this cuz this organizes the care for my baby in such a, an easy manner. And maybe even later on, apply some form of peer pressure onto your practitioner and say, Hey, look man I'm using all this makes my life super easy. You should probably do the same for your patients.

[00:17:46] Ben: So it's not if a pediatrician or a healthcare system hasn't implemented this portal on their end, then the parents are out of luck.

[00:17:53] Blake Rutherford: That is correct. So the apps reside on the app stores and anyone could pop right on there and [00:18:00] download them now.

[00:18:01] Ben: And it's

[00:18:02] Blake Rutherford: It is free.

[00:18:03] Ben: Yeah, I think that's an important component as well as are. Because you're right, as you get home from the nicu, you also get the bill for the nicu. A free app to download is a big is a big

[00:18:13] Blake Rutherford: Sure.

[00:18:14] Daphna: And you you mentioned a little bit the data about discharge planning and and really we know that our transitions of care are particularly vulnerable times for families, but really for the patients in terms of something getting missed. And we know in the nicu literature that like this discharge.

[00:18:34] Daphna: Cliff, like you said is really what parents perceive. Actually one of our parent groups just posted on Twitter not just a few weeks ago that literally picture, it feels like jumping off a cliff. We've told the parents that we are measuring every heartbeat, every ounce, every hiccup and then all of a sudden we send you home without any of that stuff.

[00:18:55] Daphna: And so I think that can be quite confusing for families to say did I really need all that [00:19:00] medicalization in the nicu or am I not getting enough in the outpatient? Realm. And I do think this this helps mitigate some of that confusion. And in fact, I think th you know the way pediatrics and neonatology has worked so much is we take things from adult medicine and we bring them down and we bring them down.

[00:19:22] Daphna: But I actually think this will serve as a model for the rest of the medical community because, even in the adult world, like people come in with, Vague symptoms and vague histories when if they had an app like this, they could literally do the symptom diary that we've all talked about, but like in a very, modern easy to use way.

[00:19:44] Daphna: I wonder what the opportunities for expansion, like something like this is.

[00:19:49] Blake Rutherford: So it's interesting you bring that up. We originally targeted routines at autism. And so the reason for that was the wide range of [00:20:00] symptoms, the wide range of therapies, the wide range of medications and everything else that's involved with caring for a child with autism. And that's was a bit of the impetus on how do we do data collection?

[00:20:13] Blake Rutherford: What's the smartest way knowing that those parents are also quite underwater, much like a parent with a brand new baby that came home from. If I could choose a goal overall for the company into the future as we continue to grow and pursue new opportunities. It would be to begin that data collection, as I mentioned, potentially in the nicu, and be able to move through the discharge planning into the high risk clinic and even follow that baby or that child at that point into 2, 3, 4, 5 year olds in which they might then.

[00:20:50] Blake Rutherford: Transition to, again, the gastro clinic or behavioral health or anything else. So when you look into what routines has and [00:21:00] has built, a lot of it is centered around developmental disorders. And again, the ability to spot some of these issues a little bit earlier than maybe we would be able to do at typical visits.

[00:21:14] Daphna: And routines. Literally the word routines is so much a part of general pediatric care, right? Like parents trying to figure out what is quote unquote normal for their child, right? And then how does that fit into what is quote unquote typical for all children. And so I just, I think all parents will find value in an app like this one.

[00:21:37] Blake Rutherford: Yeah, certainly hope so.

[00:21:40] Ben: So I think we've spoken about parents and I think it's quite, I think to me it's not such a difficult leap to make. Like Daphne said, parents keep diaries, keep logs, they keep all sorts of analog

[00:21:51] Daphna: I still have my composition book for when my daughter was an

[00:21:55] Ben: there you go. So that to me feels like a natural progression of [00:22:00] saying, Hey you, you're not limited to, like you said, your composition book, and you can actually start keeping more of a digital record. But I think also we had on the podcast a few weeks back, Dr. Agrawal and Kim Krueger from Boy, I forget I think in Arizona where they were describing their discharge and follow up program post discharge.

[00:22:17] Ben: I think there's a big push in the NICU to really try to have a more continued approach to discharge and not it being, like you guys said, like this cliff where, hey, today's the day you're getting discharged at 1400 hours and good luck to you. And so a lot of programs are, a lot of NICU are really looking for how do we establish.

[00:22:35] Ben: Pathways that can actually continue the relationship with the families until they're safely checked into their pediatrician's office and make sure that we don't just kick them out of the hospital and call it a day. It seems like routines would be a great tool to just immediately roll this out in your unit and really have.

[00:22:52] Ben: Without having to design this from scratch, really, you would have a tool available to perform that task [00:23:00] if a unit is interested. How does the setup of routines within your unit, like you mentioned this portal for providers, how does that look like? Is this something that's very exhaustive where people are like, oh my God, this is like a 10 week process where we have to train all our, or is this something that is rather seamless?

[00:23:16] Blake Rutherford: If I learned anything from the experience of hanging cameras at individual bed spaces across the world, It was that everything needs to be as painless as possible within the clinical space because everyone is already exhausted and everyone has 15 other things they could be doing instead of listening to my little inservice.

[00:23:34] Blake Rutherford: So the gist of it is, We have tried to do everything that we could to take this as far out of the hands of the IT department, for instance, by making this, as compliant and as close to the telemedicine standard that we could possibly make it, even though that's, not required for what we're building.

[00:23:55] Blake Rutherford: We've tried desperately to adhere to any type of encryption [00:24:00] or any type of security assessments that we might see specifically from the hospitals. And really when it comes to setting up the system, the facility will get basically QR codes or a variety of different ways to adjoin that set of parents to the facility, and then their information automatically then shows up in the portal.

[00:24:21] Blake Rutherford: Allowing the clinicians to check in as they see fit. A step further than that is the routine system I think relies a lot on setting up parameters and triggers. So we've talked a lot about. Feeding. But another one of the things that's come up in almost every hospital we've spoken to over the course of the few years is parental stress and being able to judge when a parent feels like they're underwater.

[00:24:51] Blake Rutherford: And so a lot of what we do is being able to raise our hand when we feel like we need help and relying on the routine system to even be able to [00:25:00] say, Hey. There've been a multitude of what we would consider more negative interactions here lately, things don't look like they're going as well as they should.

[00:25:09] Blake Rutherford: We're gonna throw up a little red flag for that particular patient, and we're going to say, Hey, this might be someone that you should reach out to and just check in. If nothing else, maybe that's a reason to bring them in for an unscheduled visit. Maybe mom just has a big group of questions cause she's super duper stressed out that particular week.

[00:25:28] Blake Rutherford: But we believe that all of that, leads to a better outcome for the family, as much for the individual patient. So setting up and getting everything underway is no different than any other project. Obviously if we're gonna connect to the E emr, that has a whole nother layer of complexity. But we'll get to that point.

[00:25:51] Daphna: I know we're getting close to time. We're over time really. We're always over time, but I. My question is really to, how do [00:26:00] things like in the digital spaces move forward medicine? And you've alluded to that a little bit. I think sometimes industry. Because of people like you who you know have been engaged with parents all along, you have your own story, obviously with time in the nicu sometimes are ahead of our medical system in engaging with the real end user, which is, patients and families.

[00:26:23] Daphna: And so I guess what is your message to us as we try to. Really reach out and include parents in our quality improvement and in our research and designing programs about how best to include them and really translate the things that they need into real outcomes.

[00:26:44] Blake Rutherford: That's a really good question. I think that in the 20 some odd years that I have been, very involved in the NICU community whether that be, from a commercial standpoint or literally living it myself, the one thing that [00:27:00] I've really noticed is the evolution of what the NICU experience looked like.

[00:27:05] Blake Rutherford: So again, 25 years ago, there were visitation hours that were super duper tight. There was one or two people at the bed space. No one had private rooms whatsoever. It wasn't dark, it wasn't quiet. A lot happened with developmental care and we really taught the parents along the way what this experience is gonna look like.

[00:27:24] Blake Rutherford: One of my favorite analogies, and maybe it'll fall on deaf ears, but it always worked for me, is going into the NICU when I was younger. My family was very involved in that space for many years before I started. It always felt like going to Tiffany's or to an expensive jewelry store as a child, like my mom would say, don't touch anything.

[00:27:44] Blake Rutherford: And everyone would stand with their arms behind their back looking into the glass at these really shiny, pretty things that we all loved, right? No one ever said, reach out and touch that thing, or, talk to that thing, or be happy that you're here in this [00:28:00] miraculous space and all the wonderful things that are happening.

[00:28:03] Blake Rutherford: So with the advent of the changes that occurred, Mainly down to involving the family as much as possible, even with family-centered rounds at this point. I think it's just simply the next step into what the NICU experience or having a medically compromised infant is really going to look like a little ways down the line.

[00:28:23] Blake Rutherford: Admittedly, there are issues with staffing. High risk infant follow-up is growing, I believe, but even with the advent of telemedicine, how does that fit into what we're trying to do here every day? Can you even do a lot of these assessments, using Zoom or Teams or whatever platform we're using nowadays?

[00:28:44] Blake Rutherford: I think that this is simply the beginning of the way medicine will look especially for infants in a very short amount of time. But we hope to be there to Sort of push that along.

[00:28:57] Ben: Blake, thank you so much for coming on the [00:29:00] show and for presenting routines to us. I think you are at the forefront of what NICU discharge and the immediate post NICU life looks like for parents and providers. We're very excited to see routines being disseminated throughout the US and throughout our community.

[00:29:14] Ben: Thank you. Thank you very much. And we will have all the information about the app. People can find out more about it at routines. It's spelled R o t i N e s.app dot aa, a p, so routines.app. And we'll have much more information on the episode page. Blake, thank you. Thank you for your time.

[00:29:33] Blake Rutherford: Thank you very much.

[00:29:36] [00:30:00]